Dr Lo Dental Office 416-226-6021

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Treatment Options

If periodontal disease is your problem, the treatment can vary widely depending on how far the diseases have progressed.  There are non-surgical as well as surgical options.  If caught in the early stages, simple procedures are done that will remove the plaque and calculus from below the gum line and disrupt the infection-causing bacteria. If these diseases have advanced to the point where the periodontal pockets are deep and the supporting bone is lost, further treatment might be necessary.  If you are not happy with your smile, there are cosmetic periodontal and dental procedures available to help you achieve the look you desire.
Non-Surgical Periodontal Treatment
Oral Hygiene
The best way to prevent periodontal disease and tooth decay -- and keep your teeth for a lifetime -- is good oral health care.  That is, through brushing, flossing and regular dental visits that include a periodontal evaluation.  Brushing and flossing remove a thin sticky film of bacteria that grows on your teeth. This sticky film, called plaque, is the main cause of tooth decay and gum disease.  For instructions see Oral Health Care page.
Scaling and Root Planning (Tissue Preparation)

Periodontal scaling is a treatment procedure involving instrumentation of the crown and root surfaces of the teeth to remove plaque, calculus, and stains from these surfaces. It is performed on patients with periodontal disease and is therapeutic, not prophylactic, in nature. Periodontal scaling may precede root planning, which is a definitive, meticulous treatment procedure designed to remove cementum and/or dentin that is rough, may be permeated by calculus, or contaminated with toxins or microorganisms. When done in a thorough fashion, some unavoidable soft tissue removal occurs. This procedure is used as a definitive treatment in some stages of periodontal disease and is part of pre-surgical therapy ("tissue preparation") in others. It is recognized that debriding the root surface is a critical element in establishing periodontal health.
Systemic Antibiotics
Numerous doctors have evaluated the adjunctive use of systemic antibiotics (by mouth) to halt the progression of Periodontal disease. Some benefit has been demonstrated when these medications are incorporated into the treatment protocol. 
Given the potential side effects of these drugs, including the development of resistant bacterial strains or increased growth of opportunistic organisms (yeast infections), incorporation of systemic antibiotic therapy into the routine management for the majority of adult periodontitis cases cannot be justified at this time.
Systemic antibiotic therapy should be reserved for patients with continuing periodontal breakdown despite meticulous conventional treatment and oral hygiene care.  In addition, patients at high risk for periodontal breakdown, such as juvenile periodontitis (genetic-predisposed) and patients with other early-onset forms of periodontitis may be treated with antibiotics in conjunction with mechanical removal of pathogens.
Topical or Local Delivery Anti-microbial Medications
Summary Statement taken from the American Academy of Periodontology
Position Paper: The Role of Controlled Drug Delivery for Periodontitis
Current data suggest that local delivery of anti-microbial into a periodontal pocket can improve periodontal health. However, these drug delivery systems do not provide a superior result when compared to scaling and root planning. Therefore, the benefits of utilizing local delivery systems as a monotherapy are questionable. In conjunction with scaling and root planning, the adjunctive use of local delivery may enhance the results in sites that do not respond to conventional therapy. A few, localized persistent lesions, in otherwise well controlled patients, may offer the greatest potential for success with this treatment modality.
It can be concluded that the adjunctive use of local drug delivery may provide a defined, but limited, beneficial response. However, the magnitude of the change anticipated by combined therapy must be interpreted in light of the severity of the defects being treated. Therefore, clinicians will need to make treatment decisions based on the desired outcomes of therapy. Furthermore, concerns with respect to the impact of widespread antibiotic use in dentistry suggest that local delivery devices should only be used in specific areas where conventional forms of therapy may fail to control the infection. Therefore, as with systemic anti-microbial therapy, local anti-microbial therapy should not be used routinely in situations when efficacious results can be accomplished with scaling and root planning.
Periostat®
Periostat® is a pill taken orally consisting of a sub-anti-microbial dose of the antibiotic doxycyline. It has no direct influence on the germs that cause periodontitis. Periostat® reduces the activity of the periodontal patient's overproduction of gum and tissue-destroying enzymes. Periostat® is taken in conjunction with scaling and root planning. Typically the drug is taken for no less than three months.
Periodontal Surgery
Soft Tissue Grafts
Soft tissue grafts can be used to increase gum tissue thickness or possibly cover exposed roots where gum is absent due to excessive gingival recession. During this procedure your periodontist takes gum tissue from your palate or another donor source to augment tissue thickness or cover the exposed root if possible.
A soft tissue graft can help inhibit further recession. In some cases it can cover exposed roots. This may reduce tooth sensitivity and improve esthetics of your smile.
Frenetomy
A frenotomy is the surgical removal of a frenum in the mouth. A frenum is a fold of tissue that passes from the movable lip or cheek to the gum. A frenotomy is indicated when a frenum is positioned in such a way as to interfere with the normal alignment of teeth or results in pulling away of the gum from the tooth surface causing recession.
Gingivectomy
Since the bacteria that causes periodontal disease breed in the deepened pockets between the gum and the tooth, your dentists may attempt to eliminate the area in which this bacteria can grow with a gingivectomy.
In a gingivectomy, the doctor will trim the unhealthy gum in order to reduce the pocket size. As a result, the bacteria will no longer have a suitable environment in which to grow, and healthy gum tissue can begin to grow back.
Pocket Reduction Procedures
(Information from The American Academy of Periodontology)
 Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed, forming "pockets" around the teeth.
Over time, these pockets become deeper, providing a larger space for bacteria to live. As bacteria develop around the teeth, they can accumulate and advance under the gum tissue. These deep pockets collect even more bacteria, resulting in further bone and tissue loss. Eventually, if too much bone is lost, the teeth will need to be extracted.


Mild Periodontis


Advanced Periodontis

During this procedure, your doctor folds back the gum tissue and removes the disease-causing bacteria before securing the tissue into place. In some cases, irregular surfaces of the damaged bone are smoothed to limit areas where disease-causing bacteria can hide. This allows the gum tissue to better reattach to healthy bone.
There are many benefits to this procedure. Reducing pocket depth and eliminating existing bacteria are important to prevent damage caused by the progression of periodontal disease and to maintain a healthy smile. Eliminating bacteria alone may not be sufficient to prevent disease recurrence. Deeper pockets are more difficult for you and your dental care professional to clean, so it's important for you to reduce them. Reduced pockets and a combination of daily oral hygiene and professional maintenance care increases your chances of keeping your natural teeth ¡V and decreases the chance of serious health problems associated with periodontal disease.
Periodontal Regenerative Procedures
(Information from The American Academy of Periodontology)
Your bone and gum tissue should fit snugly around your teeth like a turtleneck around your neck. When you have periodontal disease, this supporting tissue and bone is destroyed and pockets develop. Eventually, if too much bone is lost, the teeth will need to be extracted.
Your doctor may recommend a regenerative procedure when the bone supporting your teeth has been destroyed. These procedures can reverse some of the damage by regenerating lost bone and tissue.
During this procedure, your doctor folds back the gum tissue and removes the disease-causing bacteria. Membranes (filters), bone grafts or tissue- stimulating proteins can be used to encourage your body's natural ability to regenerate bone and tissue.
There are many options to enhance support for your teeth and to restore your bone to a healthy level. Your doctor will discuss your best options with you.

The benefits of this procedure are eliminating existing bacteria and regenerating bone and tissue helping to reduce pocket depth and repair damage caused by the progression of periodontal disease. With a combination of daily oral hygiene and professional maintenance care, you'll increase the chances of keeping your natural teeth ¡V and decrease the chances of serious health problems associated with periodontal disease.
Bone Regeneration
The ability to regenerate bone around teeth and on edentulous jaw ridges in association with implant reconstruction is called "Guided Bone Regeneration". This remarkable therapy has given patients who have already lost teeth a second chance to enjoy the benefits of permanent teeth with the help of dental implant reconstruction. 
It is known that bone heals more slowly than the gum tissues in the mouth. Without Guided Bone Regeneration techniques, the faster healing gum would prevent the bone from maximizing its full healing potential following surgical procedures. The concept of treatment is simple. A biocompatible membrane is placed between the gum and bone which acts as a barrier. This barrier prevents downgrowth of the gum into the underlying bone as it heals. Oftentimes, a bone graft is placed into the underlying bony irregularities, under the membrane, to help the body grow new bone. Membranes around teeth are typically designed to dissolve away after several weeks of healing have passed. Membranes used to restore bony ridges in association with implant therapy are typically non-resorbable, and must be removed at a later date.
Ridge Augmentation
This surgical procedure uses a barrier membrane and or bone graft replacement material placed under the gum and over the remaining bone support (ridge or jaw bone) to enhance regeneration of new bone in an area where teeth are being extracted or have already been removed. The graft material may be from the patient's own body (autogenous bone) or an artificial, synthetic, or natural substitute. This is done to build up the bone support in an area in anticipation of the  placement of a dental implant or to improve the shape and contour of the ridge (jaw bone) prior to placing a  bridge or a partial denture. To put it more simply, it prevents the collapse of the surrounding bone into the extraction socket after the removal of a tooth; if this is not done, the ridge becomes narrow and sharp and not conducive to the placement of an implant or for a comfortable-fitting denture.
Cosmetic Surgery
Crown Lengthening
During this procedure excess gum and bone tissue is reshaped to expose more of the natural tooth. This can be done to one tooth, to even your gum line, or to several teeth to expose a natural, broad smile.
Your dentist may also recommend crown lengthening to make a restorative or cosmetic dental procedure possible. Perhaps your tooth is decayed, broken below the gum line, or has insufficient tooth structure for a restoration, such as a crown or bridge. Crown lengthening adjusts the gum and bone level to expose more of the tooth so it can be restored.
Root Coverage
This procedure covers exposed roots and stops tissue recession. The transplanted tissue should be strong, protective, and natural-looking gingiva (gum). Compared to gingival augmentation, a root coverage procedure should also help prevent root decay, reduce root sensitivity, and improve appearance.

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